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Ascending Aorta Dissection Before 5.5 cm Diameter; "It Wasn't Raining When Noah Built the Ark"
Nikolaos A Papakonstantinou1, Filippos-Paschalis Rorris2, Constantine N Antonopoulos3
1Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada.
Heart, Lung & Circulation
|December 8, 2022
Summary
Acute aortic dissection in non-syndromic patients occurred at a smaller diameter than the 5.5 cm surgical threshold. This suggests current guidelines may need revision for earlier intervention and prevention of thoracic aortic aneurysms.
Area of Science:
- Cardiovascular Surgery
- Thoracic Aortic Disease
- Aortic Dissection
Background:
- Current guidelines recommend elective ascending aortic repair for non-syndromic thoracic aortic aneurysms at a diameter of 5.5 cm.
- The optimal diameter threshold for intervention in acute aortic dissection remains a subject of investigation.
Purpose of the Study:
- To compare the mean maximum ascending aortic diameter at the time of acute aortic dissection with the established surgical threshold for elective repair.
- To evaluate the potential benefits of adjusting the current diameter-based surgical threshold.
Main Methods:
- Prospective enrollment of 31 adult patients with non-syndromic acute type A aortic dissection.
- Measurement of maximum aortic diameter at dissection and comparison with the 5.5 cm elective repair threshold.
- Assessment of secondary endpoints including mortality, aortic length, and Euroscore II.
Main Results:
- Mean maximum aortic diameter at dissection was 5.13 cm, significantly lower than the 5.5 cm threshold (p=0.004).
- Mean aortic length was significantly greater than normal controls (p<0.001), with a length/height ratio of 6.18 cm/m.
- 30-day/in-hospital mortality was 35.5%, and actual preoperative Euroscore II was significantly higher than predicted for elective repair.
Conclusions:
- The maximum aortic diameter at acute type A aortic dissection in non-syndromic cases is significantly below the current 5.5 cm threshold for elective repair.
- Lowering the diameter-based threshold may improve prevention, but further research is warranted.
- Length-based thresholds could potentially aid in the timely prevention of aortic dissection.
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